Ship To


	Ship To			Bill To
Name			Name
Address			Address
City			City
State			State
Zip			Zip
Attention			Attention


Agent / Distributor Name		List Price
E-mail Address		Selling Price
Purchase Order Number		Commission
		Dealer Price



Qty		Type		Type Extension		Cover


Lead Length		Lead Position		Connector
				Color

Dim X (L)

Dim Y (W)

Dim Z (H)